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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2019  |  Volume : 30  |  Issue : 3  |  Page : 749-750
Ralstonia infection among hemodialysis patients: A summary

1 TWS Medical Center, Bangkok, Thailand
2 Department of Community Medicine, Dr. D. Y. Patil University, Pune, Maharashtra, India; Department of Biological Science Joseph Ayobabalola University, Ilara-Mokin, Nigeria

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Date of Submission05-Sep-2018
Date of Acceptance16-Sep-2018
Date of Web Publication26-Jun-2019

How to cite this article:
Sriwijitalai W, Wiwanitkit V. Ralstonia infection among hemodialysis patients: A summary. Saudi J Kidney Dis Transpl 2019;30:749-50

How to cite this URL:
Sriwijitalai W, Wiwanitkit V. Ralstonia infection among hemodialysis patients: A summary. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2020 Sep 25];30:749-50. Available from: http://www.sjkdt.org/text.asp?2019/30/3/749/261367

To the Editor,

Ralstonia spp. is a Gram-negative bacterium that is considered a new emerging infection among immunocompromised patients.[1] Patients undergoing hemodialysis (HD) are also considered at-risk group to acquire Ralstonia infection. Here, the authors summarize previous publications on Ralstonia infection among patients undergoing HD. There are at least nine reported cases of Ralstonia infection in HD patients,[2],[3],[4],[5] with six males and three females, aged between 32 and 75 years (average: 55.4 ± 15.3 years). Those nine reported cases are as follows: India – five cases, Uruguay – two cases, Malaysia – one case, and Bulgaria – one case. The first clinical presentation in all cases was acute fever. Septic workup by standard microbiological examination was used to identify bacterial pathogen in blood samples in each case. Microbiologically, the pathogen species were Ralstonia mannitolilytica in six cases (66.6%) and Ralstonia pickettii in three cases (33.3%). Complications such as endocarditis was observed in one case and thrombosis of the arteriovenous fistula was observed in another case. All cases recovered after standard intravenous antibiotic treatment for Gramnegative bacteria based on drug sensitivity results. The corresponding pathogen was successfully isolated from the dialysis water purification system for HD unit in all cases. Indeed, the water in the hospital was reported for high contamination rate of Ralstonia spp.[6] Regarding the microbiological pattern, R. mannitolilytica seems to be the predominant species.

Conflict of interest: None declared.

   References Top

Ryan MP, Adley CC. Ralstonia spp.: Emerging global opportunistic pathogens. Eur J Clin Microbiol Infect Dis 2014;33:291-304.  Back to cited text no. 1
Lim CT, Lee SE. A rare case of Ralstonia mannitolilytica infection in an end stage renal patient on maintenance dialysis during municipal water contamination. Pak J Med Sci 2017;33:1047-9.  Back to cited text no. 2
Tejera D, Limongi G, Bertullo M, Cancela M. Ralstonia pickettii bacteremia in hemodialysis patients: A report of two cases. Rev Bras Ter Intensiva 2016;28:195-8.  Back to cited text no. 3
Strateva T, Kostyanev T, Setchanova L. Ralstonia pickettii sepsis in a hemodialysis patient from Bulgaria. Braz J Infect Dis 2012; 16:400-1.  Back to cited text no. 4
Shankar M, Rampure S, Siddini V, Ballal HS. Outbreak of Ralstonia mannitolilytica in hemodialysis unit: A case series. Indian J Nephrol 2018;28:323-6.  Back to cited text no. 5
[PUBMED]  [Full text]  
Vincenti S, Quaranta G, De Meo C, et al. Nonfermentative gram-negative bacteria in hospital tap water and water used for haemodialysis and bronchoscope flushing: Prevalence and distribution of antibiotic resistant strains. Sci Total Environ 2014;499:47-54.  Back to cited text no. 6

Correspondence Address:
Won Sriwijitalai
TWS Medical Center, Bangkok
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DOI: 10.4103/1319-2442.261367

PMID: 31249248

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